The adoption of federal health care reform legislation entitled the Patient Protection and AffordableCare Act (ACA) in 2010, the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, along with market forces, have further incentivized the development of health care payment and delivery models that require integration, alignment and/or collaboration among physicians and other health care providers. The ACA, for instance, establishes pilot programs and laws under Medicare to test and evaluate new payment and delivery models, such as accountable care organizations (ACOs), bundled payments, independence at home demonstration program, readmission reduction program, and hospital-acquired conditions. See 42 U.S.C. §§1395jjj, 1395cc-4, and 1395ww. Generally speaking, the MACRA will base payment increases (or decreases) to providers based on their performance on a weighted formula composed of quality, efficiency, meaningful use, and clinical practice improvement activities. Commercial payors have already deployed or plan to deploy similar methodologies. For more information on MACRA, see CMA ON-CALL document #7210, “MACRA Overview.”